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General NPI Number Information
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NPI Number | 1518607258
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Entity Type | Organization
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Legal Business Name | MINDY ESTELLA VILLA
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Dates
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Enumeration Date | 03/30/2022
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Last Update Date | 01/25/2023
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Provider Practice Location Address
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Address Line | 1155 MCNUTT RD STE 104
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City | SUNLAND PARK
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State | NM
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Zip | 88063-9176
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Country | US
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Telephone | 915-202-4463
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Fax |
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Provider Business Mailing Address
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Address Line | 1155 MCNUTT RD STE 104
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City | SUNLAND PARK
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State | NM
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Zip | 88063-9176
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Country | US
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Telephone | 915-202-4463
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MINDY VILLA
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Credential | ANP-BC
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Telephone | 915-202-4463
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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